第75章 骨盆及髋臼骨折(王满宜).ppt

第75章 骨盆及髋臼骨折Fractures of Pelvis and Acetabulum Fractures of Pelvis ?Pelvic pathology: Undisplaced/minmally displaced/displaced: Stable fracture Partially stable fracture (rotational) Completely unstable (rotational and vertically/translationally) Isolated iliac wing fractures Undisplaced pubic ramii fractures Transverse fractures of sacrum below pelvic ring Os coccygis fracturesAll pelvic ligaments intact! Unstable pelvic fractures: Partially stable: Rotationally unstable: External/internal rotation (lateral compression) Flexion/extension Abduction/adduction Completely unstable: Rotationally and vertically (translationally) unstable Partially stable pelvic fractures: Rotationally unstable: Open book fractures external rotation Lateral compression fractures internal rotation External rotation: Mechanisms of injury: Posterior crush Direct pressure ASIS External rotation through femur(s) Rupture symphysis/sacrospinous lig./anterior sacroiliac lig Always posterior and interosses sacroiliac ligaments intact! External rotationally unstable fracture: Partially stable pelvic fractures: Disruption of symphysis only: Slight external rotation Widening of symphysis max. 2.5 cm = Open book injury External rotationally unstable fractures: Partially stable pelvic fracture: Disruption of symphysis, sacrospinous ligament and anterior sacroiliac ligament: Open book injury Massive external rotation PSIS abuts sacrum: External rotational instability External rotationally unstable fractures: Partially stable pelvic fracture: Disruption of symphysis, sacrospinous ligament,  all sacroiliac ligaments: Open book injury with: Massive external rotation Flexion Transition to vertical/translational instability Internal rotation: Mechanisms of injury: Direct pressure to iliac crest Force against greater trochanter femoral head acetabul